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Multidisciplinary Approach to Perihilar and Intrahepatic Cholangiocarcinoma: A Single-Center Experience
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Abstract
Background/Aims: Treatment of perihilar cholangiocarcinoma (PHCC) and intrahepatic cholangiocarcinoma (IHCC) is a challenging issue. We aimed to investigate the clinical characteristics of both tumors and the outcome of our treatment policy.
Material and Methods: We retrospectively analyzed data of 117 patients who were diagnosed with PHCC or IHCC between January 2007 and September 2023. Postoperative outcomes and the effects of prognostic factors on overall survival (OS) were investigated.
Results: Surgical resection was performed on 47 patients (PHCC, n = 33 and IHCC, n = 14). Preoperative biliary drainage was applied in 32 of 33 cases with PHCC and 2 of 14 cases with IHCC. The mortality rate was 8.5% (n = 4). The complication rate was 68.1%. The R0 resection rate was 73% in PHCC. The mean OS time of PHCC cases that underwent R0 resection was 26.5 ± 24.8 months. The mean OS time of patients who underwent resection for IHCC was 28.7 ± 35.5 months. The OS was poorly affected by high CA19-9 levels (≥37 U/mL) (P = .005), the presence of lymphovascular invasion (P = .049), positive surgical margins after resection (P < .001), and the development of postoperative acute renal failure (P = .078). The OS of patients receiving adjuvant chemotherapy was significantly longer (P = .071). CA19-9 levels of more than 37 U/mL (P = .027) and positive surgical margin (P < .001) were independent factors for poor OS.
Conclusion: Surgical resection is the mainstay of multidisciplinary treatment for PHCC and IHCC. In advanced stages of IHCC, the combination of loco-regional therapies and repeat surgery, along with the enhanced efficacy of systemic chemotherapy, plays a significant role in a patient’s survival.
Cite this article as: Gundogdu A, Anil Kodalak T, Kucukaslan H, et al. Multidisciplinary approach to perihilar and intrahepatic cholangiocarcinoma: A single-center experience. Turk J Gastroenterol. 2025;36(1):34-44.
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References
1. Cillo U, Fondevila C, Donadon M, et al. Surgery for cholangiocarcinoma. Liver Int. 2019;39(suppl 1):143-155. [CrossRef]
2. Murakami Y, Uemura K, Sudo T, et al. Perineural invasion in extrahepatic cholangiocarcinoma: prognostic impact and treatment strategies. J Gastrointest Surg. 2013;17(8):1429-1439. [CrossRef]
3. Seyama Y, Makuuchi M. Current surgical treatment for bile duct cancer. World J Gastroenterol. 2007;13(10):1505-1515. [CrossRef]
4. Bismuth H, Corlette MB. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg Gynecol Obstet. 1975;140(2):170-178.
5. Weber SM, Ribero D, O’Reilly EM, Kokudo N, Miyazaki M, Pawlik TM. Intrahepatic cholangiocarcinoma: expert consensus statement. HPB (Oxford). 2015;17(8):669-680. [CrossRef]
6. Topaloglu S, Inci I, Calik A, et al. Intensive pulmonary care after liver surgery: a retrospective survey from a single center. Transplant Proc. 2013;45(3):986-992. [CrossRef]
7. Topaloglu S, Yesilcicek Calik K, Calik A, et al. Efficacy and safety of hepatectomy performed with intermittent portal triad clamping with low central venous pressure. BioMed Res Int. 2013;2013:297971. [CrossRef]
8. Bodur MS, Tomas K, Topaloğlu S, et al. Effects of intraoperative blood loss during liver resection on patients’ outcome: a single-center experience. Turk J Med Sci. 2021;51(3):1388-1395. [CrossRef]
9. Arslan MK, Aydin C, Topaloglu S, Calik A, Tomas K, Karabulut E. Incidence of and risk factors for incisional hernia after liver surgery performed with a J-shaped right subcostal incision. Am Surg. 2017;83(2):e49-e53.
10. Tomas K, Oguz S, Topaloglu S, et al. Is it rational to perform liver resection for patients with intermediate and advanced stages of hepatocellular carcinoma? Am Surg. 2020;86(4):313-323.
11. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-213. [CrossRef]
12. Rahbari NN, Garden OJ, Padbury R, et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery. 2011;149(5):713-724. [CrossRef]
13. Ocak İ, Topaloğlu S, Acarli K. Posthepatectomy liver failure. Turk J Med Sci. 2020;50(6):1491-1503. [CrossRef]
14. Amin MB, Edge SB, Greene FL, et al. AJCC Cancer Staging Manual. 8th ed. Berlin: Springer; 2017:295-316.
15. Oguz S, Kucukaslan H, Topaloglu S, et al. Is it possible to increase survival of patients with intrahepatic cholangiocarcinoma? A case report. J Gastrointest Cancer. 2021;52(1):342-346. [CrossRef]
16. Corvera CU, Blumgart LH, Darvishian F, et al. Clinical and pathologic features of proximal biliary strictures masquerading as hilar cholangiocarcinoma. J Am Coll Surg. 2005;201(6):862-869. [CrossRef]
17. Mizuno T, Ebata T, Yokoyama Y, et al. Combined vascular resection for locally advanced perihilar cholangiocarcinoma. Ann Surg. 2022;275(2):382-390. [CrossRef]
18. Moggia E, Rouse B, Simillis C, et al. Methods to decrease blood loss during liver resection: a network meta-analysis. Cochrane Database Syst Rev. 2016;10(10):CD010683. [CrossRef]
19. Topaloğlu S, Sağlam K, Çalık A, Cobanoğlu Ü, Öztürk MH. Synchronous occurrence of hepatocellular carcinoma and intrahepatic cholangiocarcinoma in both lobes of the liver. Turk J Gastroenterol. 2014;25(2):209-211. [CrossRef]
20. Krasinskas AM. Cholangiocarcinoma. Surg Pathol Clin. 2018;11(2):403-429. [CrossRef]
21. Mueller M, Breuer E, Mizuno T, et al. Perihilar cholangiocarcinoma—novel benchmark values for surgical and oncological outcomes from 24 expert centers. Ann Surg. 2021;274(5):780-788. [CrossRef]
22. Oguz S, Tayar S, Topaloglu S, Calik A, Dinc H, Ozturk MH. Enhancing hepatic microcirculation in postoperative hepatic failure with intra-arterial recombinant tissue plasminogen activator treatment. Exp Clin Transplant. 2017. [CrossRef]